How intertwined are the roles of Patients, Frontline Workers and Healthcare Leaders in ensuring Patient Safety?

According to the Institute for Healthcare Improvement (IHI) website, Patient Safety Awareness Week is an annual recognition event intended to encourage everyone to learn more about health care safety. During this week, IHI seeks to advance important discussions locally and globally, and inspire action to improve the safety of the health care system — for patients and the workforce. Patient Safety Awareness Week serves as a dedicated time and platform for growing awareness about patient safety and recognizing the work already being done. It is commemorated in March, and as we gear up for the 2022 Patient Safety Awareness Week we would like to recap last year’s conversations and perhaps decide how to build on them as well as review any strides that have been made since then towards improving healthcare.

ACQUIRE, AfiHQSA, COHSASA and Patient Safety Africa are a group of like minded individuals who had the desire to form a movement that ensures that people are working together to gurantee quality and safety of patient care in Africa as a continent. They initiated and moderated conversations, with frontline workers, patients, healthcare leaders and other interested parties, aimed at enlightening and sharing ideas that can be encouraged and developed to ensure quality of healthcare and best patient care practices in the continent.

The two day event was facilitated through a Patient Focus webinar and a Leadership and System focus webinar.

The patient focus webinar was two part;

i) Health Systems Causes of Adverse Events among Obstetric Clients in a Tertiary Facility in Ghana by Elom Otchi, Technical Director of AfiHQSA

Research (Adhikari 2016) has shown that a staggering 43 million Adverse Effects (AEs) occur each year worldwide causing 23 million Disability Ajusted Life Years (DALYs).  Out of these 43 million AEs, two-thirds occur in lower middle income countries including those in the African continent. Obstetric AEs, which was the focus of the discussion is associated with an excess mortality of 15 deaths per 10,000 patients globally while the prevalence of obstetric AEs in Ghana lies at 12%. These statistics reveal the enormous burden of unsafe care facing the healthcare system and the immediate consequence of diminished trust and sense of satisfaction for both the patients and the health professionals. These AEs are caused by gaps in leadership/governance, inadequate medical technology, outdated hospital Management Information Systems and wanting service delivery at the medical facilities.

The good news however is that over 87% of AEs are preventable through synergy and a systematic approach to dealing with the above golden blocks. Some of the brilliant recommendations brought forth  when adopted will lead to healthcare systems that are designed to be safe for both the patients and providers.

  RECOMMENDATIONS:   Improved communication lines between patients and healthcare givers.Adopting the more effective communication method between staff members using SBAR (Situation, Background, Assessment and Recomendation).A coherent quality improvement and patient safety programmeEstablishing clarity in accountability and reporting framework for AEsAvailability and implementation of protocols/guidelines of all patient care processes.  

In essence, the creation and sustainance of a patient safety culture across hospitals and all health facilities is key in driving down the AEs statistics and in raising patient and healthcare workers confidence. This means; a learning, reporting and just culture for all.

ii)  Developing a Rapid-cycle Frontline QI Process to Support Employee Well-Being and Drive Institutional Responsiveness in a Tertiary Care Faith-based Hospital in Kenya by Mary B. Adams (Co-founder of ACQUIRE)

There is a strong association between employee well-being and quality patient care that cannot be overlooked in pursuit of patient safety awareness. The resilience, dedication and collaboration amongst health workers is greatly enhanced when they work in a safe and enabling environment. The covid 19 pandemic provided a “perfect storm” in Kenya, as in many other African countries, with the medical uncertainty of facing a novel infectious disease within the background of organizational disruption and financial distress. Hence the question; how do you create a safe space for staff to share their concerns and voice frustrations while being heard and respected?

AIC Kijabe hospital came up with Focus groups that were led and guided by neutral facilitators that identified the greatest staff needs and provided real time feedback loops for decision makers to act on. The staff shared their personal coping mechanisms which facilitated employee cross-learning and the acknowledgement of a shared experience. Most importantly, the question “What can the Hospital do for you to help you cope with this?” was posed. Answers were collected and analysed in the most confidential manner to assure staff of protection and trust in the process. Notable responses that the hospital management acted on include but are not limited to; institutional preparedness towards ensuring employee well-being as well as the need for constant communication of changes in protocols, expectations and covid risk reduction measures. In essence, employee well-being is hinged greatly on open communication channels between staff and management/leadership.

What must healthcare leaders therefore know and do?

A presentation on the second day of the webinars by Dr. Lydia Okutoyi, founding president of Society for Quality Healthcare Kenya (SQQHK) and co founder of ACQUIRE on ; Improving Medical Error Reporting in Africa (A scoping review) spurred an informative session.

The panel consisted of highly skilled and placed individuals who sit at the apex and inform how things are done;Dr. Margaret Meme – Programme Manager, Division of Reproductive Health under the Ministry of Health and Sanitation (Sierra Leone), Dr. Daniel Kiura – Head of Quality Assurance Department at Mater Misericordiae Hospital (Kenya), Mary Muraya – Head of Quality and Standards at the Nairobi Women’s Hospital (Kenya), DR. Emmanuel Srofenyo – Medical Director at the Greater Accra Regional Hospital (Kenya) and Dr. Robert Nyarango – Chief Executive Officer of Getrude’s Children’s Hospital (Kenya).

Their collective contributions offer a wealth of information and ideas for best practices to ensure patient safety within the continent:

  • Develop a national policy in conjuction with the Ministry of Health on patient safety care at a national level to act as a guide for hospitals.
  • Establish quality assurance systems and processes within individual healthcare facilities. Back this up with capacity building, training and mentorship for both healthcare staff and hospital directors.
  • Lobby for support from the hospital board and management. Educate them on the benefit of patient safety and care. This will ensure appropriate resource allocation towards quality improvement and patient safety.
  • Develop a culture of continous research and learning, mainly from previous errors and benchmarking against acceptable standards in the industry.
  • Encourage non punitive accountability and reporting.
  • Establish feedback patterns and patient partnership to ensure that they are constantly heard.
  • Encourage health workers to practice empathy. How would you like to be treated if you were the patient?

To cap the patient, frontline healthcare workers and healthcare leaders relationship, it seems then that there’s great need for not just empathy but communication and management of expectations across board. It is necessary for the patients to understand that their own engagement in the care they receive will impact greatly on the outcome of the treatment. Speaking up and asking questions should therefore not be frowned upon but should be encouraged to both ensure a just culture and allow patients to make informed decisions on their own treatment. Standard Operating Procedures (SOPs) are also a key aspect of each healthcare facility in ensuring standardised care. They allow the care givers to avoid improvisations and follow through on laid down guidelines and reporting channels. This openness and communication model as established so far demonstrates great potential for changing and improving the level of care offered and received by patients in Africa.

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